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5' <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> 0 WATER WELL DRILLERS REPORT NO. 2 9 0 6 ,41 <br /> ltttc of Intuit No <br /> L.nca] Permit Nu or Date_._„88-2a6l St it( Wcl! No <br /> Other bkt_II No �O T) <br /> (1) OWNER Na., T a <br /> �! <br /> (12) WELL LAG Total depth ane Ft Completed depth�]�ft <br /> Address <br /> C Itv <br /> ZIY from Ft to ft Formation (Describe b� color character size or material) <br /> 10 '2Qft Clay <br /> (2) LOCATION OF WELL (See instructions) — <br /> 24 C:Jay <br /> Connty Sari JOa. 111 Owncr s Well iNinnher - <br /> Well address if different from above _ <br /> Town3litp Range ' ail SC ec toe - <br /> 174 Sand <br /> Distance from cities roads railroads fences ctc 174 - <br /> 210 <br /> 212 <br /> 42 300 rl <br /> (3) TYPE OF WORK - <br /> New Well nr Deepening ❑ , <br /> Reconstruction ❑ - <br /> Reconditioning <br /> Horizontal Well ❑ - \ 'j <br /> Destruction ❑ (Describe <br /> destruction materials and pro- _ \ <br /> cedures In Item 12) <br /> (4) PROPOSED US <> <br /> Dourest c Pr1v. <br /> Irrigation v � <br /> rndastr al �� I❑ �- `� f <br /> Test Well \�� � ❑ ` \� '! <br /> %Iunicijifla 1 J\ �� ✓ <br /> Other <br /> WEI L LOCATION SKETCH -,be) �� - <br /> �l <br /> LS) EQLIFMENT (6) GRAVEL PACK <br /> Rotary $I Reverse ❑ ,— & No%� <br /> Cable ED Air <br /> ❑ `\ etej pf bore <br /> \ <br /> Other - <br /> El $ucket�,�.[]� �c a rom �_`t�_- X77 �� <br /> (7) CASING INSTALLED (6) PERF6"Ti(?I7S _ <br /> Steel ❑ Plastic 1� , n Ty of( for] on or size of <br /> From T i Gage or Z \ t _ <br /> ft ft i Wall t size - <br /> 7 - <br /> (9) WELL SEAL \� _ <br /> Was surface sanitary seal provided? Yes M< No ❑ If yes to dept h___JjD„0_____ft <br /> were strata sealed against poilutionYes ❑ No ❑ Interval ft — <br /> Methodofsealing 14'ork started c <br /> 1J Cnmpleted ]gam <br /> Dept WATER LEVELS WELL DRILLERS S C kTFiNlr_NT <br /> Depth of hest water if known Ft <br /> Standinglevclafter wc[lcompletion 1his tnell tI [lrrlhd rrnrltr my jurisdiction and this report s true to lire <br /> ft be,' of my krtouled"t aid bi lu f� <br /> (1 1) WELL TESTS !J <br /> tli to i made Yes ,i;ned <br /> ❑ No Cl❑ IE yes by whnrrt� (Wt II Driller) <br /> ,E test Pump ❑ Railer ❑ Air lift ❑ <br /> Oh to wlter.it Start of test ft <br /> \t r nd of It st ft {Person oriel or arrporauorr)(Tv-F d or printed) <br /> thseharge gal/nunaftcr iuuvs WattT <br /> rit nit>,ratltre Add rc tis <br /> C he 174-1 <br /> nrrcal analyus rnI Yes ❑ No ❑ If sts by whuniP ( itY <br /> Was tleetnclogmade Yes 52 IIP 1 5380 <br /> ❑ No ❑ If vr>,attatht opv In this it Iwrt ] t.cri5e No III of this report <br /> owR ,eta tFIE , <br /> V 1211 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 96 96355 <br />